IDSA: Obesity, Not Wasting, Now a Concern for HIV Patients

Action Points

Explain to interested patients that weight gain has become a problem for HIV patients much as it is for the rest of the population.

Explain also that the weight gain is attributable to patients living longer, healthier lives with HIV because of more effective treatment.

Point out that the findings were reported at a medical conference and as a published abstract and should be considered preliminary until they have appeared in a peer-reviewed journal.

SAN DIEGO, Oct. 5 -- Once stereotyped as wasting away, HIV patients have joined the rest of America in fighting the battle of the bulge, according to results of a study reported here.

More than 60% of a group of HIV-positive patients met criteria to be classified as overweight or obese, Nancy Crum-Cianflone, M.D., of the TriService AIDS Clinical Consortium of San Diego, told attendees at the Infectious Diseases Society of America meeting.

In contrast, none of the patients met the strictest standards for wasting, and only 3% met looser standards, she said.

Dr. Crum-Cianflone credits the advent of highly active antiretroviral therapy with the transition from wasting to excess weight.

"This is a clear demonstration that HIV medications have really revolutionized the treatment of patients," she said. "In many ways, we see this finding as encouraging--our patients are living long lives and are now having the same medical issues as the general population," Dr. Crum-Cianflone added.

At the outset of the HIV epidemic, longer survival equated with weight loss and wasting, in part because of the lack of effective therapies. To examine trends in body weight among HIV patients, investigators examined records on 663 patients treated at U. S. Navy medical centers in San Diego and Bethesda, Md.

Wasting was defined as a body mass index (BMI) less than 20; normal weight as a BMI of 20 to 25; overweight as a BMI of 25 to 29; and obese as a BMI of 30 or greater.

By BMI standards, 17% of the patients were obese, and 46% were overweight. Only 20 patients (3%) had BMI values that reflected wasting. When the stricter wasting criterion of a BMI of 18.5 or less was applied, none of the patients met the standard.

The mean duration of HIV infection in the patients in the study was 10 years. At diagnosis 49% of the patients had met BMI definitions for overweight or obese, and that proportion increased by almost a third at the time of follow-up. Moreover, Dr. Crum-Cianflone and colleagues found that 72% of the patients gained weight during follow-up (mean 12.8 pounds).

More than 70% of the patients were on HAART at the time of the study. Neither duration of HAART nor the type of regimen influenced BMI values.

In particular, the investigators found no association between body habitus and use of protease inhibitors, which some studies have implicated in weight gain and adverse effects on lipids and anthropometric parameters.

"One of the predictors of weight gain was length of HIV infection, meaning the longer a patient had been infected, the more likely the patient was to gain weight," said Dr. Crum-Cianflone. "We see that as another indication of the effectiveness of HAART."

"We believe the drugs have led us out of the wasting era but have not necessarily led us into the era of overweight and obesity," she added.

Another study reported at IDSA yielded similar findings related to body weight. A review of records on 70 older HIV-positive patients (mean age 56) showed that 52% were either overweight or obese, said Nur Onen, M.D., of Washington University in St. Louis.

Compared with an age-matched control group of non-HIV patients, the HIV cohort had a similar prevalence of heart disease and diabetes. The HIV patients did have a higher rate of hypertension (51% versus 31%). Additionally, HIV-positive patients had higher triglyceride levels, lower levels of LDL-cholesterol and blood glucose, and similar rates of osteoporosis and insulin resistance.

The patients and control group had similar 10-year Framingham risk scores for coronary disease. Parameters of cognitive function also were similar between the groups.

"HAART probably is not as toxic as people once believed," said Dr. Onen. "People are doing so well on HIV medication, we need to start looking at other health issues."

Dr. Crum-Cianflone reported no conflicts. Dr. Onen has received research grant support from Bristol Myers-Squibb.

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